title: Anxiety, anger, and mortality risk among survivors of myocardial infarction.
abstract: BACKGROUND
  Although there is evidence that anxiety and anger are associated with a higher risk of cardiovascular events, studies examining the relationship between these stressors and prognosis following myocardial infarction have been mixed.
  
  
  METHODS
  We conducted a prospective cohort study of 1968 participants (average age 60.2 years, 30.6% women) in the Determinants of Myocardial Infarction Onset Study recruited at the time of admission for myocardial infarction between 1989 and 1996. We used the state anxiety and anger subscales of the State-Trait Personality Inventory. Participants were followed for all-cause mortality through December 31, 2007 using the National Death Index. We constructed multivariable Cox proportional hazards models adjusted for demographic, behavioral, and clinical confounders and calculated hazard ratios (HR) and 95% confidence intervals (CI) to examine the relationship between high levels of anxiety and anger and all-cause mortality.
  
  
  RESULTS
  Over 10 years of follow-up, 525 participants died. Compared with those scoring lower, an anxiety score >90(th) percentile was associated with a 1.31-times (95% CI, 0.93-1.84) higher mortality rate. The association was apparent in the first 3 years (HR 1.78; 95% CI 1.08-2.93), but not thereafter. Likewise, an anger score >90(th) percentile was associated with a 1.25-times (95% CI, 0.87-1.80) higher mortality rate. The association was higher in the first 3 years (HR 1.58; 95% CI, 0.91-2.74) than in subsequent years, but it was not statistically significant during either follow-up period.
  
  
  CONCLUSIONS
  In this study of myocardial infarction survivors, a high level of anxiety was associated with all-cause mortality, with the strongest association in the first 3 years of follow-up.
authors.affiliation: Department of Cardiology and Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Wrenn
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mostofsky
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Tofler
authors.forename: James E
authors.initials: JE
authors.lastname: Muller
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000368:Aged; D000786:Anger; D001007:Anxiety / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000523:psychology*; D012306:Risk
keywords: All-cause mortality; Anger; Anxiety; Myocardial infarction